Archived: Brendoncare The Old Parsonage

At the last inspection January 2017, we found a breach of regulations 12 and 15 of the Health and Social Care Act (Regulated Activities) Regulations 2014. During this inspection we found improvements had been made and the service had met the requirements of these regulations.

Brendoncare The Old Parsonage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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Brendoncare The Old Parsonage provides accommodation and personal care for up to 28 people who may be living with dementia. The accommodation is provided over two floors accessed by a passenger lift which was out of service at the time of inspection. The provider had made arrangements for people to access both floors in the absence of the passenger lift. There were a number of communal areas where people could sit together or alone if they wished. There was also a garden which was safe for people to access independently. At the time of inspection, the provider was in the process of closing the home and was working with people to transition to one of their other homes. There were 23 people living at the home at the time of inspection.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was rated Requires Improvement at our last inspection in January 2017 and had breached two regulations in relation to safe care, and premises and equipment. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet the breach and improve the key questions of Safe and Well Led to at least Good.

At this inspection, we found that the provider had made sustained improvements to its medicines management system to ensure the safe ordering, storage, administration, recording and disposal of medicines. We also found the provider had robust systems to monitor the safety of the environment and equipment within the home.

The registered manager had taken on feedback from the last inspection to ensure they took appropriate action to ensure the service made the improvements required. They were open and transparent in their approach and people told us their feedback and complaints were dealt with in a professional and reasonable manner.

The registered manager was well liked and respected by people, relatives and staff. They had sustained improvements made since the last inspection and carried out a series of audits and checks, which helped them monitor the quality and safety of the service. The registered manager was supportive of staff and understood people’s needs.

There was a friendly, caring and relaxed environment at the service. People told us staff were caring and attentive, treating them with dignity and respect. Staff were very knowledgeable about people’s needs and approached their role with enthusiasm and confidence.

There were sufficient numbers of staff in place to meet people’s needs. The provider had safe and effective systems around recruitment, training, induction and supervision to support their staff in their role.

The provider had established very close links to the local community. This relationship helped to provide support, activities and comfort to people. The service had many volunteers who would regularly visit to offer people company and support. People told us they felt at home living at the service and that they were supported to maintain links with the local community and loved ones.

People received personalised care. Staff were aware of people’s preferences and routines and care was provided to reflect this. There were a wide range of activities in place for people to join in with. People were involved in developing the service, this included influencing menu choices and new activities they wished to try.

Risks to people’s health and wellbeing were assessed and monitored. The service had a proven track record in providing highly effective care for people at risk of developing pressure injuries.

The support people required around their eating and drinking was identified in their care plans. People had access to healthcare services as required and people’s care plans were updated with their changing needs. The registered manager had developed positive working relationships with other stakeholders to help provide positive outcomes for people. The home was a clean and hygienic environment and there were systems in place to protect against the risk of infections spreading.

The provider was in the process of closing the home. People had been consulted about the changes and offered alternative accommodation at one of the provider’s other services. People told us they were made to feel involved in the process through visits, updates and contributing to choices around decoration and décor. The registered manager carefully considered how to minimise any disruption during the move and had worked with people to formulate individualised transition plans which were designed with their needs in mind.

The environment at the home met people’s needs, although the registered manager had recently needed to make adaptations considering the passenger lift being out of service. With the impending closure in mind, people and relatives agreed for the adaptation of existing space to meet the needs of people living on the first floor as opposed to repair of the lift. The registered manager appreciated these were only effective short-term measures until the home closed.

The provider had a caring and compassionate ethos. The senior management were a visible presence within the home and the provider had systems in place to support people financially if they were unable to meet the cost of their care.

There were systems in place to protect people from abuse and harm. Staff had all received training to help them identify abuse and actions to take to protect people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

At our previous inspection of 9 and 10 June 2015, we found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Brendoncare The Old Parsonage’ on our website at www.cqc.org.uk.

We undertook a comprehensive inspection on 23 January 2017 to follow up on those previous breaches and to check that the service now met the legal requirements.

At this inspection, we found the provider had taken sufficient action and resolved the issues we found at our previous inspection of June 2015. However, they remained in breach of the regulation in relation to safe care and treatment as people’s medicines were not managed appropriately. The provider had introduced an electronic medicines management system and was having set-up problems.

The provider had strengthened the management of the service and had appointed a registered manager since our last inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had identified risks to people’s health and put measures in place to protect them from risk of harm. They followed guidance in place to manage the risks safely.

There was a sufficient number of competent staff deployed to meet people’s needs. The provider used appropriate procedures for safe recruitment of staff suitable to provide care and had recruited more nurses since our last inspection.

Staff were trained in safeguarding people and followed the provider’s policy on how to keep people safe. They knew how to recognise abuse and understood their responsibility to report concerns. The registered manager ensured staff received support, relevant training and regular supervision to maintain their competency to support people.

People’s privacy and dignity were respected. Staff provided their care with kindness and compassion. People were involved in planning their day to day lives. People had sufficient food and drink and accessed healthcare services when needed. Specialist care was provided for people who were nearing the end of their lives and in line with their wishes.

People’s needs were assessed and reviewed regularly to ensure staff provided appropriate support. Staff had support plans with guidance on how to provide care to people. People received personalised care that reflected their preferences and choices.

People gave consent to staff before they received care. Staff supported people in line with the principles of the Mental Capacity Act 2005 and the requirements of the Deprivation of Liberty Safeguards. People’s views were sought and their feedback was used to make improvements to the service. The registered manager knew how to resolve complaints in line with the provider’s procedure.

There was an open culture at the service. Staff were able to raise concerns about the service and felt valued by the registered manager. The quality of the service was subject to regular checks and audits by the registered manager and additional quality assurance reviews by senior managers. Audit findings were used to develop the service.

People who lived at The Old Parsonage told us that they felt well cared for, that food was good and said that staff responded promptly to requests for assistance. People praised the staff. They said for example, "they select staff carefully, we have some lovely staff here' and another said, 'they know what they are doing.'

Staff described The Old Parsonage as 'a lovely happy home' and another said it was 'very organised.'

We found that people's health, care and nutritional needs had been assessed and staff followed guidance to ensure that people's needs were met. There was a good range of training for staff which helped to ensure that they could fulfil their roles and responsibilities. The service responded appropriately to complaints made.

Procedures were unclear about how staff obtained valid consent to the care, treatment and support that people required. Senior staff were aware that this was an area that required clarification and work was underway to improve systems to gain and review consent from people.

Staffing levels had increased. The service had employed an additional care staff each afternoon. Staff we spoke with said that although it was at times very busy, the additional staff member had made a difference. They said that there were enough staff on duty to meet people's collective needs. Staff rotas we saw reflected the increase in staffing levels. We judged therefore that the provider was now meeting this standard.

People told us that they liked the home and said that they were well treated. One person said "It's calm, friendly and homely." This was a representative view. We observed staff responding to people positively and in a respectful way.

People's health and care needs were recorded. Staff had a good understanding about what support people required. The service made good use of published research and guidance to help to ensure that they continued to develop their good practice in terms of care and treatment.

People said that they felt safe at the home.

Staff told us that training and support that they received helped them to do their job effectively. People told us that the service was well organised and well managed. Our observations during our visit substantiated this. There were a number of quality monitoring systems in place which helped the service to check that it was operating effectively.

Opinion was divided about whether there were enough staff on duty at all times to meet everyone's collective needs. We had minor concerns that the service did not have sufficient staff.